Voluntary health insurance in Europe.

• Individuals opt for Voluntary Health Insurance (VHI) to fill the gaps in publicly funded health coverage or to enjoy quicker access to medical treatment and a broader selection of healthcare providers. The role VHI plays in a particular healthcare system is significantly influenced by the healthcare policies related to publicly funded health insurance and the regulatory environment. These factors are shaped by the historical development of the insurance system in a given country, as well as the political ideology and interests of various stakeholders. Additionally, it depends on the government's ability to shape and cultivate the health insurance market.

• There are 4 main VHI roles that address diffrent gaps in health care sector. 1) substitutive 2) supplementary 3) complementary covering user fees 4) complementary covering services not covered by basic benefit package. Frequently, multiple distinct markets function simultaneously within the country (see figure Summary of VHI roles in Europe). 

• Although there is significant diversity in the size, operation, and oversight of voluntary health insurance markets, the majority of them are relatively small in scale. In most CEE countries, the proportion of healthcare expenses covered by voluntary health insurance is relatively small (less than 5%). Exceptions are commercial markets in Slovenia (14.1% in 2014) and Croatia (6.9 % in 2014).

• In Slovenia, the collection of user fees is a common practice across all healthcare services. The only exceptions are children and students up to the age of 26, who are exempt from these fees. Even individuals with chronic illnesses are not exempt, and there is no cap on the fee amount (Albreht et al., 2022). The fee amount is determined based on the cost of the healthcare service and is set as a percentage contribution, ranging from 5% to 90%. The high levels of cost-sharing and the desire to protect oneself from the burden of significant financial expenses, especially during hospitalizations, have driven the adoption of VHI (84% of population had one in 2014!).

• Similary, in Croatia, the provision of healthcare services also involves user fee payments. These fees apply when visiting doctors (around 1.3 euros for a general practitioner and 2.6 euros for a specialist), during hospital stays (6.6 euros per day for the first 30 days), and as a co-payment for medications or medical aids (preventive care and emergency services are exempt). Unlike in Slovenia, exemptions from these fees are extended not only to children but also to pregnant women and individuals with chronic illnesses.

• More interesting information about VHI in Europe you can find in publication Voluntary health insurance in Europe: role and regulation from Anna Sagan and Sarah Thomson from The European Observatory on Health Systems and Policies (2016) https://www.ncbi.nlm.nih.gov/books/NBK447647/pdf/Bookshelf_NBK447647.pdf

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Albreht T, Polin K, Pribaković Brinovec R, Kuhar M, Poldrugovac M, Ogrin Rehberger P,Prevolnik Rupel V, Vracko P. (2021) Slovenia: Health system review. Health Systems inTransition, 2021; 23(1): pp.i–188.